As we approach the holidays, now may be an appropriate time to point out the rules relating to gifts that providers can give to Medicare and Medicaid beneficiaries. During this time of the year, some healthcare professionals may want to give gifts to their patients, other physicians or even referral sources. Before you do, consider this: It can land you in a heap of trouble with the federal government unless you follow the law. In December 2016, the Health and Human Services Office of the Inspector General released a policy statement regarding gifts of nominal value to Medicare and Medicaid beneficiaries. At that time, the OIG raised the nominal value of gifts allowed from having a retail value of no more than $10 per item or $50 in aggregate annually per beneficiary to $15 per item or $75 in aggregate annually per beneficiary.

Study Finds Hospital Outpatients Are Sicker and Tend to Come from Lower-Income Communities

Written by American Hospital Association

Friday, 28 September 2018 12:33

Medicare patients who receive care in a hospital outpatient department (HOPD) are more likely to be poorer and have more severe chronic conditions than Medicare patients treated in an independent physician office (IPO). The study also specifically examined the characteristics of Medicare cancer patients seen in HOPDs and IPOs and found similar results.

The findings of this new study, conducted for the American Hospital Association by KNG Health Consulting LLC, highlight why proposals under consideration by Congress to reimburse hospitals the same amount as physician offices could threaten access to care for the most vulnerable patients and communities.

"America's hospitals and health systems are proud to provide care and emergency services 24/7 to all who come through the door regardless of their ability to pay," said AHA President and CEO Rick Pollack. "But as this study clearly shows, the needs of the patients hospital outpatient departments care for each day are different from those who choose to be seen at an independent physician office. Proposals that treat them the same ignore the very different clinical and regulatory demands hospitals face, and could threaten access to care."

I am a terrible coder. I think I am a pretty good doctor, but when it comes to coding, the process of figuring out which billing code to pick to assign to a bill for an office visit, I am hopeless. No matter how many times I have had the rules explained to me, or how much feedback I have been given about specific visits, or which "pocket guide" to coding I have been handed over the years, I can't seem to get it right. Even my errors are non-systematic. Sometimes I "overcode" (picking a visit level insufficiently supported by my note) and other times "undercode." And the things I get wrong are all over the map - sometimes my history lacks some "elements," sometimes my review of systems covers the wrong number of systems, sometimes my exam is shy an organ or two ... you get the idea. It is very hard to get better if you keep doing different things wrong. Of course, this begs the question why doctors should be coding as well as doctoring, but that is an issue for another day.

For now, my deficiency explains why I was intrigued to learn that CMS recently proposed changing the rules governing the coding and reimbursement for physician office visits.

Jeffrey Sachs, a professor and director of the Center for Sustainable Development at Columbia University, lays out the argument for Medicare for All (M4A) in an opinion piece posted to CNN.com on August 4. Dr. Sachs' analysis is flawed. In his idealized description of a Single Payer healthcare system, he overlooks several problems associated with such a scheme including: lack of innovation, lack of capital investment and unmet demand (resulting in long waiting times for healthcare services). That said, Dr. Sachs does highlight several issues that hamper our current health system...

By now I'm sure that you have all heard about Medicare's proposed changes to Evaluation and Management (E&M) reimbursement in 2019. The majority of physicians I've spoken to are confused by Medicare's rationale and frustrated with the proposal. A change claiming to lessen the burden of physicians seems to promote the opposite for those physicians seeing primarily level 4 patients. The proposed reduction in payment could force them to see more patients to maintain similar revenue.